Charcot关节病4例报告

Charcot’s arthropathy:4 case report

目的探讨夏科氏关节病的临床诊断和治疗。方法回顾性分析4例夏科氏关节病患者的临床资料。结果Ⅰ,14岁,男性,以"左足第一、二踇趾肿胀、流脓1年余"为主诉就诊。该患者约1年前无明显原因出现左足第一和第二踇趾肿胀,脓肿及活动受限。X线片示严重的第一趾关节脱位和骨破坏。Ⅱ,26岁,女性,例1的姐姐,以"左侧腘窝处皮肤破溃流脓2月余"为主诉就诊。膝关节X线片示左侧胫腓骨中远端骨质缺如,右侧胫骨近端骨质密度不均。通过详细的病史询问,体格检查和辅助检查,确诊为夏科氏关节病。Ⅲ,45岁,男性,3年前出现双手手指关节肿胀伴脱位,皮肤感觉麻木、发凉。Ⅳ,41岁,女性,例3的妹妹,两年前手指关节肿胀并脱臼,皮肤感到麻木和寒冷。1年前的不规则治疗逐渐出现坏死和关节丢失。结论夏科氏关节病在临床上少见,直系亲属间发病的情况更少。该疾病的误诊率很高,骨科医生需要加深对它的认识以免贻误治疗。

Objective To investigate the clinical diagnosis and treatment of arthropathy of Charcot.Methods Retrospective analysis of 4 case of Charcot’s arthropathy was conducted.ResultsⅠA 14-year-old male presented to the hospital with the chief complaint of“swelling and discharge of the first and second hallux toes for more than one year”.About 1 year ago,the patient developed swelling,abscess,and limited movement of the first and second hallux of the left foot without apparent cause.Radiographs showed severe dislocation and bone destruction of the first digit.ⅡA 26-year-old female patient,the sister of patient 1,presented to the hospital with the chief complaint of“skin ulceration and pus in the left popliteal fossa for more than 2 months”.Radiographs of the knee showed bone deficiency at the left tibia and fibula and uneven bone density at the right proximal tibia.A detailed history,physical examination,and supplementary examination confirmed the diagnosis of arthropathies charcot.ⅢA 45-year-old male presented with swelling and dislocation of the finger joints of both hands 3 years ago,numbness and cooling of the skin.ⅣA 41-year-old female,sister of patient 3,had swollen and dislocated finger joints two years ago,and the skin felt numb and cold.The irregular treatment of a year ago gradually developed necrosis and joint loss.Conclusions Arthropathy of Charcot is rare in clinic,especially among lineal relatives.The misdiagnosis rate of this disease is high,and orthopedic surgeons need to be more aware of it so as not to delay treatment.